Natural birth control post-partum (while breastfeeding)

You’ve had a baby and are breastfeeding and you don’t want to have another baby too close to your current baby. That means birth control.

The (not so) fun thing about birth control post-partum is that your options are a little more limited if you are breastfeeding. And if you want to use natural methods to ensure that nothing is messing with your milk, they can be more difficult post-partum than during normal cycles.

All this is to say, a lot of people have issues with figuring out birth control soon after baby. Because of that, a lot of people look for a natural birth control method and have a hard time making heads or tails of whether something like the sympto-thermal method of fertility awareness is possible post-partum and how the heck to even use it, if so. I get questions about fertility awareness post-partum frequently and decided to write a post about some of the basics.

(Note: ALWAYS at least read a full book on the sympto-thermal method before trying to use it as birth control yourself. Even better? Take a class).

First things first: Is fertility awareness effective post-partum?

The long and the short of it is YES. It is still doable and effective as a birth control method post-partum, so if you want to use it you don’t need to worry about decreased efficacy because you don’t have a “normal” cycle. The sympto-thermal method of fertility awareness is based on fertility signs you check on a daily basis and not previous cycle calculations.

What’s the difference between fertility awareness and the lactational amenorhea method?

The lactational amenorrhea method (or LAM) is a completely different method of birth control. With LAM, you can only use it if you meet the following criteria:

Your baby is less than 6 months

You exclusively breastfeed (ALL food and drink from breastfeeding and no pumping and bottle feeding)

You have not had your first post-partum period

LAM is about 98% effective in preventing pregnancy if you meet all the criteria. However, I do not usually recommend using LAM alone because most LAM studies have been done outside of the US where breastfeeding style and typical diets of the mothers differ. If anyone knows of studies done in the US or similar countries I would love to know about them!

Are there any challenges to fertility awareness post-partum?

Yes! Though fertility awareness is very doable there are a couple challenges. One is that there are generally a lot more days of potential fertility than if you are cycling normally. That is because fertility is determined by the presence of cervical fluid and most people will have a lot of days of cervical fluid before actually ovulating.

Because of this, you need to feel comfortable with your cervical fluid observations and comfortable having a long period of fertility or else you will REALLY hate using fertility awareness while breastfeeding.

Fertility awareness can also be more challenging post-partum for those who haven’t ever used the method pre-pregnancy. That’s because fertility awareness has an element of recognizing your own patterns. Getting to know those patterns can be more difficult when you are not cycling because you are not confirming ovulation and then able to look back at everything and decipher what’s going on and use your new insight on the next cycle.

What can you expect to see on a chart post-partum?

Everyone is different, but in general most people will have a dry period before they start getting cervical fluid again. When you DO start getting cervical fluid again, it can often take the form of a basic infertile pattern, meaning you have fluid but it is unchanging and not of the most fertile quality. When there is not change in mucus (and it’s not a peak type of mucus) you are able to establish a basic infertile pattern and use those days like dry days using special rules.

But seriously, this is the trickiest part of past-partum charting. You have to know how to classify cervical fluid correctly, check cervical fluid correctly, notice changes in quality of cervical fluid, and then eventually most people need to deal with long periods of fertile fluid, too.

Because it’s so important to be able to check and chart your cervical fluid correctly and it’s the one sign you really have to go off of, it can be important to take a class or work with a teacher if you are confused.

If post-partum is feeling tough for you personally because you have days on days of very fertile fluid (and you know for sure that you are checking and charting correctly and it’s the most fertile type), unfortunately, that’s somewhat normal and something that you just have to live with for some time.

The good news? Post-partum ends.

Are other methods of fertility awareness better or more accurate than the sympto-thermal method for post-partum?

One thing most people can’t really keep up with at first post-partum is taking their temperature. With inconsistent sleep schedules it isn’t easy! Of course, the most important part of the sympto-thermal method is cervical fluid, so you can conceivably just check cervical fluid until you start seeing your peak type and start temping then. Since temperatures are important to confirm ovulation and not before ovulation, you are not missing out on important temperatures this way.

Some people even forgo temperatures all together and know that their efficacy will be a bit lower this way, but that since they likely have lower fertility they’d rather just do the easiest thing possible and only track their cervical fluid.

Drawn to things like persona/clearblue monitor and the marquette method? These tools are not increasing efficacy, per se, but can give you more infertile days and make post-partum tracking more palatable because of that. The efficacy can decrease because you can get more “false negative” days with hormone testing. You can be fertile but the monitor doesn’t catch it. However, with the sympto-thermal method you still have the great efficacy, but almost everyone who charts post-partum has more “false positive” days, meaning days that you are potentially fertile based on fertility signs, but you don’t actually end up being fertile.

Some devices, like temperature only devices, are really not appropriate for post-partum charting, unless you are only wanting to catch your first ovulation but not worried about birth control before that first ovulation (which is, of course, important if you are intent on avoiding pregnancy).

I realize this post is getting a little long, but I frequently get questions about post-partum charting and birth control. What questions do you have that aren’t answered here? I can do a follow-up post with more answers in the future. :)

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Comments

I’ve needed this post. I tried temping, but it was ridiculous. We just passed that 6 month sweet spot, and I’ve really just been hoping. (I read somewhere that after six months you’re more likely to ovulate before your period returns).

So now to buckle down and actually start tracking cf.

Thanks for addressing this! I somehow forgot that I could still track cf.

I’m 15 month post partum and still no period. As you suggest I am just charting cervical fluid and because I have charted cervical fluid before I haven’t found it too hard. I still breastfeed a lot so will be interesting to see when my period returns – I don’t feel a return to fertility anytime soon atm. A lot of people I know say LAM doesn’t work but like anything you have to follow the rules – was fine for me the first 6 months. Thanks Hannah as always for your great posts.

Despite the fact that I breastfed both my babies all the time my cycles returned at 2.5 and 4months respectively. That meant I was temping while my sleep was still pretty erratic. I found that to my surprise the temperature readings were more consistent and resilient that I had imagined they would be. I still do careful CF checks of course to catch the fertile wave, but its been a big relief to see that I can temp well despite the inconsistent sleep and varied wake times. Curious if you’ve seen that for others as well?

Yes, I think that’s really common, actually! Usually the biggest problem is people forgetting to temp or getting confused about the best time to temp and just not temping because of that. I think temps (for most people) are way more resilient than we give them credit for. There is also the issue of people just not knowing when a temp is outlying enough to throw it out or still regard it as part of their curve.